Psychological Disorders

As we study this topic realize that it is normal to have problems and fear not being normal. So relax!

PREVALENCE & PERSPECTIVES

400 Million people worldwide suffer psychological disorders (W.H.O.)

20% of American adults had an active disorder while 32% reported having experienced a psychological disorder at some time in their life. NIMH

Females- internalized and passive disorders (depression, anxiety, inhibited sexual desire)

Males-externalized and active mental disorders (antisocial, alcohol abuse, impulse control problems)

Mental Disorders account for 15.4 percent of the years of life lost due to death or disability.

PREVALENCE & PERSPECTIVES II

Those who experience a psychological disorder usually do so by early adulthood. Over 75% report their first symptoms before age 24 (NIMH). Antisocial personality disorder and phobias appear earliest

at ages 8 and 10 respectively. Most other disorders symptoms appear at a median age of

20-25.

Two Major Perspectives of Etiology Medical Model (know) Bio-Psycho-Social Perspective (know)

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Defining and Diagnosing

Engaging in Abnormal Behavior does not mean that a person has a Mental Disorder (Mental Illness)

Insanity is a legal term (refers to whether a person is aware of his or her actions and can control them.

Psychological Disorders are common in all cultures. Most disorders are characterized by very common behaviors.

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Dilemmas of Definition

Mental Disorders as a Violation of Cultural Standards Visions, “Sexual Preference”

Mental Disorders as Emotional Distress Sexual Interest, Preference

Mental Disorders as Behavior that is Self-Destructive to Self or Others Social Phobia, Alcohol Use, Cutting

Diagnostic and Statistical Manual DSM-IV Current Standard for Defining Disorders

Axis I: Clinical Syndromes Axis II: Personality Disorders Axis III: General Medical Conditions Axis IV: Psychosocial and Environmental Conditions Axis V: Global Assessment of Functioning Scale

Each diagnosis must include certain signs and symptoms. Use of DSM-IV results in 83% agreement between therapists. DSM-IV diagnosis is necessary for reimbursement by almost all

insurances. Arguments against using the DSM-IV include the negative

impact of labels.

DSM-IV Diagnostics for Depression Major Depressive Disorder (DSM-IV Criteria)

Person must experience either markedly depressed mood or marked loss of interest in pleasurable activities most of every day for at least 2 weeks.

In addition the person must experience at least four or more of the following symptoms during the same period:

Fatigue or loss of energy Insomnia or hypersomnia Decreased appetite and weight loss or gain Psychomotor agitation or retardation Diminished ability to think or concentrate Self denunciation (worthlessness) or excessive guilt Recurrent thoughts of suicide or death

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Dilemmas of Diagnosis

Classifying Disorders (DSM) Diagnostic and Statistical Manual (DSM)

Primary Aim is to Descriptive Major Categories on page 355 1952=86 pages//2000=900 pages

Currently Contains Over 400 Diagnoses Reasons include precise diagnosis for treatment of

disorders and for insurance purposes.

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Dilemmas of Diagnosis Problems with DSM

Overdiagnosis Labeling Confusion of Serious with Normal Problems Illusion of Objectivity and Universality

(Eg.) Drapetomania- urge to escape from slavery

Advantages of DSM Improves Reliability of Diagnosis Now Includes Culture Bound Syndromes Indicates that Some Syndromes are Universal

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Dilemmas of Measurement

Projective Tests Objective Tests

Projective Tests Projective Tests:

Psychological tests used to infer a person’s motives, conflicts, and unconscious dynamics on the basis of the person’s interpretations of ambiguous stimuli.

Rorschach Inkblot Test: A projective personality test

that asks respondents to

interpret abstract, symmetrical

inkblots.

Objective Tests

Inventories: Standardized objective questionnaires requiring written

responses; they typically include scales on which people are asked to rate themselves.

Minnesota Multiphasic Personality Inventory (MMPI):

A widely used objective personality inventory Consists of ten categories or subscales including

depression, schizophrenia, paranoia, and introversion Inventories are the most reliable and valid

Beck Depression Inventory Child Behavior Checklist (observations)

Defining and Diagnosing Disorder

Dilemmas of Definition Diagnosis: Art or Science?

Dilemmas of Definition

Possible Models for Defining Disorders: Mental disorder as a violation of cultural standards. Mental disorder as maladaptive or harmful behavior. Mental disorder as emotional distress.

Mental Disorder: Any behavior or emotional state that causes an individual

great suffering or worry, is self-defeating or self-destructive, or is maladaptive and disrupts the person’s relationships or the larger community.

Diagnostic and Statistical Manual II Problems with the DSM

Danger of Over-diagnosis The Power of Diagnostic Labels Confusion of Serious Mental Disorders with Normal Problems The Illusion of Objectivity

Advantages of the DSM If Used Correctly with Valid Tests it Increases Reliability of DX Helps Distinguish Between Disorders that are Similar. Provides a Similar Language for Discussion Mental Disorders.

Assessment and Measurement Assessment

Precedes and continues throughout treatment. Two General Areas of Assessment

Biological (physical exam) Psychosocial (interviews and psychological testing)

Measurement Projective Rorschach Inkblot

Thematic Apperception Test Objective Tests- Standardized Questionnaires

Beck Depression Inventory MMPI (Personality Test) Child Behavior Checklist (observations)

Concerns About Diagnostic System

The danger of overdiagnosis

The power of diagnostic labels

Confusion of serious mental disorders with normal problems

The illusion of objectivity

Anxiety Disorders

Anxiety Disorders

Anxiety and Panic Fears and Phobias Obsessions and Compulsions

Anxiety and Panic Generalized Anxiety Disorder:

A continuous state of anxiety marked by feelings of worry and dread, apprehension, difficulties in concentration, and signs of motor tension.

Women make up 2/3 of those diagnosed with GAD GAD involves not being able to identify the cause of

the anxiety

Generalized Anxiety Criteria

DSM-IV Criteria are as Follows: Includes chronic excessive worry about a number of events

and activities (not identified) Must occur more days than not for at least 6 months Worry must be accompanied by at least 3 of the following

Restlessness or feelings of being keyed up or on edge A sense of being easily fatigued Difficulty concentrating or mentally going blank Irritability Muscle tension Sleep disturbance

Panic Disorder

Panic Disorder: An anxiety disorder in which a person experiences

recurring panic attacks, feelings of impending doom or death, accompanied by physiological symptoms such as rapid breathing and dizziness.

Smokers have a fourfold risk of a first-time panic attack.

Panic Disorder

The person must have experienced recurrent unexpected attacks and must have been consistently concerned about having another attack or worried about the consequences of having another attack (losing control / going crazy) for at least one month. To be considered a full blown panic attack the episode must involve

the abrupt onset of at least 4 of 13 symptoms e.g.: Shortness of breath Heart palpitations Sweating Dizziness Depersonalization (feeling detached from ones body) Derealization (feeling that the outside world is unreal) Fear of dying, going crazy, losing control

Posttraumatic Stress Disorder

Posttraumatic Stress Disorder (PTSD): An anxiety disorder in which a person who has

experienced a traumatic or life-threatening event has symptoms such as psychic numbing, reliving the the trauma, and increased physiological arousal.

Fears and Phobias

Phobia: An exaggerated, unrealistic fear of a specific situation, activity, or object.

Obsessive Compulsive Disorder An anxiety disorder in which a person feels trapped in

repetitive, persistent thoughts (obsessions) and repetitive, ritualized behaviors (compulsions) designed to reduce anxiety. Obsessions- persistent and recurrent intrusive thoughts, images, or

impulses that are experienced as disturbing and inappropriate. Compulsions- overt repetitive behaviors (such as hand washing,

checking or ordering) or covert mental acts (such as counting, praying, or saying certain words silently).

The person feels driven to perform the compulsive behavior in response to an obsession.

The person must recognize that the obsession is a product of their own mind rather than from external sources

The involuntary behavior must cause marked distress, consume excessive time, or interfere with occupational or social functioning.

EXPLAINING ANXIETY DISORDERS

The Learning Perspective Fear conditioning Stimulus Generalization Reinforcement Observational Learning

The Biological Perspective Evolution Genetics Physiology

Mood Disorders

MOOD DISORDERS Major Depressive Disorder is considered the common cold

of mental health. Women are twice as vulnerable to major depression than

men. Most major depressive episodes last less than 6 months. With each new generation, the rate of depression is

increasing and the disorder is striking earlier.

Mood Disorders

Depression and Bipolar Disorder Theories of Depression

Depression

Major Depression: A mood disorder involving disturbances in

emotion (excessive sadness), behavior (loss of interest in one’s usual activities), cognition (thoughts of hopelessness), and body function (fatigue and loss of appetite).

Symptoms of Depression

Depressed mood Reduced interest in almost all activities Significant weight gain or loss, without dieting Sleep disturbance (insomnia or too much sleep) Change in motor activity (too much or too little) Fatigue or loss of energy Feelings of worthlessness or guilt Reduced ability to think or concentrate Recurrent thoughts of death

DSM IV Requires 5 of these within the past 2 weeks

Gender, Age, and Depression

Women are about twice as likely as men to be diagnosed with depression. True around the world

After age 65, rates of depression drop sharply in both sexes.

Theories of Depression

Biological explanations emphasize genetics and brain chemistry.

Social explanations emphasize the stressful circumstances of people’s lives.

Attachment explanations emphasize problems with close relationships.

Theories of Depression

Cognitive explanations emphasize particular habits of thinking and ways of interpreting events.

“Vulnerability-Stress” explanations draw on all four explanations described above.

Bipolar Disorder

Bipolar Disorder- a mood disorder in which the person alternates between the hopelessness and lethargy of depression and the overexcited state of mania. Manic states are characterized by a hyperactive, wildly, optimistic state. Equal numbers of men and women present with this

disorder.

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Explaining Mood Disorders The Biological Perspective

Genetic Influences The Depressed Brain

The Social Cognitive Perspective Negative Thoughts Feed Negative Moods Negative Moods Feed Negative Thoughts Depression’s Vicious Cycle

Cognitive Habits Attribution and Locus of Control

Diathesis (vulnerability)-Stress Model of Depression Diathesis can be biological or environmental. Stressor-a situation or circumstance that is perceived by the

individual to exceed his or her personal resources.

Personality Disorders

Personality Disorders

Problem Personalities Antisocial Personality Disorder

PERSONALITY DISORDERS Coded on Axis II of the DSM-IV Defined as: 1) Long-standing, 2) pervasive, and 3) inflexible

patterns of behavior and inner experience that deviate from the expectations of a persons culture and that impair social and occupational functioning.

A personality disorder is defined by the extremes of several traits and by the rather inflexible and maladaptive way these traits are expressed.

The personality each of us develops over the years reflects a persistent means of dealing with life’s challenges, a certain style of relating to other people (overly dependent, shy, aggressive, appearance)

Problem Personalities

Narcissistic Personality Disorder: A disorder characterized by an exaggerated

sense of self-importance and self-absorption.

Paranoid Personality Disorder: A disorder characterized by habitually

unreasonable and excessive suspiciousness and jealousy.

Antisocial Personality Disorder

Antisocial Personality Disorder (APD): A disorder characterized by antisocial behavior such as

lying, stealing, manipulating others, and sometimes violence; and a lack of guilt, shame and empathy.

Sometimes called psychopathy or sociopathy.

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Dissociative Identity Disorder

Dissociative Disorders

Dissociative Disorders: Conditions in which consciousness or identity is split or

altered.

Dissociative Identity Disorder: A controversial disorder marked by the appearance

within on person of two or more distinct personalities, each with its own name and traits; commonly known as “Multiple Personality Disorder (MPD).”

Dissociative Disorder

The number of cases exploded from only 2 cases per decade from 1930 to 1960 to more than 20,000 cases in the 1980’s.

This disorder is almost nonexistent outside of the U.S.

Considered by Britain as a “Wacky American Fad” Considered by skeptics to be created by therapists in

a particular social context.

Flaws in MPD Diagnosis

Flaws in Underlying Research Pressure and Suggestions by Clinicians Influence of the Media

Drug Abuse and Addiction

Drug Abuse and Addiction

Biology and Addiction Learning, Culture, and Addiction Debating the Causes of Addiction

Biology and Addiction

Some people have a biological vulnerability to addiction.

This may be due to their metabolism, biochemistry, or personality traits.

Biology and Addiction

Heavy drug abuse also changes the brain in ways that make addiction more likely

Learning, Culture, and Addiction

Addiction patterns vary according to cultural practices and the social environment.

Policies of total abstinence tend to increase addiction rates rather than reduce them.

Not all addicts have withdrawal symptoms when they stop taking a drug.

Addiction does not depend on the properties of the drug alone, but also on the reason for taking it.

Drugs and Vietnam Veterans

US Soldiers who tested “drug positive” in Vietnam showed a dramatic drop in drug use when they returned to civilian life.

This contradicts what the biomedical model of addiction would predict.

Debating the Causes of Addiction

Problems with drugs are more likely when: A person has a physiological vulnerability to a drug. A person believes she or he has no control over the drug. Laws or customs encourage people to take the drug in

binges, and moderate use is neither tolerated nor taught. A person comes to rely on a drug as a method of coping with

problems, suppressing anger or fear, or relieving pain. Members of a person’s peer group use drugs or drink

heavily, forcing the person to choose between using drugs or losing friends.

Schizophrenia

Schizophrenia

Symptoms of Schizophrenia Theories of Schizophrenia

Symptoms of Schizophrenia

Bizarre Delusions Hallucinations and Heightened Sensory

Awareness Disorganized, Incoherent Speech Grossly Disorganized and Inappropriate

Behavior

Delusions and Hallucinations

Delusions: False beliefs that often accompany schizophrenia and

other psychotic disorders.

Hallucinations: Sensory experiences that occur in the absence of

actual stimulation.

Positive and Negative Symptoms

Positive Symptoms Cognitive, emotional, and behavioral excesses

Examples of Positive Symptoms Hallucinations Bizarre Delusions Incoherent Speech Inappropriate/Disorganized Behaviors

Positive and Negative Symptoms

Negative Symptoms Cognitive, emotional, and behavioral deficits

Examples of Negative Symptoms Loss of Motivation Emotional Flatness Social Withdrawal Slowed speech or no speech

Theories of Schizophrenia

Genetic predispositions Structural brain abnormalities Neurotransmitter abnormalities

Theories of Schizophrenia

Prenatal abnormalities Adolescent abnormalities in brain development

MRI scans show that aperson withSchizophrenia (left) is more likely than a healthy person (right) to have enlarged ventricles.

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